The State of the World’s Children 2008 provides a wide-ranging assessment of the current state of child survival and primary health care for mothers, newborns and children. These issues lie at the heart of human progress, serving as sensitive barometers of a country’s development and well-being and telling evidence of its priorities and values. Investing in the health of children and their mothers is not only a human rights imperative, it is also a sound economic decision and one of the surest ways for a country to set its course towards a better future.

The remarkable advances in reducing child deaths that many developing countries have achieved in recent decades provide reason for optimism. Since 1960, the earliest year for which the number of child deaths per year is currently available, the annual number of child deaths around the world has been halved. And yet, much remains to be done, because every day, on average, more than 26,000 children under the age of five die around the world, mostly from preventable causes. Nearly all of them live in the developing world or, more precisely, in 60 ’priority’ developing countries and territories.

Child survival: main threats and solutions

More than one third of all child deaths occur during the first 28 days of life. Many of these these children die at home, without access to essential health services and basic commodities that might have saved their lives. Some children succumb to respiratory or diarrhoeal infections that are no longer threats in industrialized countries or to early childhood diseases, such as measles, that are easily prevented through vaccines. Up to half of all under-five deaths are associated with undernutrition, which deprives a young child’s body and mind of the nutrients needed for growth and development. Unsafe water, poor sanitation and inadequate hygiene also contribute to child mortality and morbidity.

The key interventions needed to address the major causes of child deaths are well established and accepted. In fact, research reveals that only about 1 per cent of deaths among children under five have unknown causes and that up to two thirds of them are entirely preventable. The most basic, yet important, services and practices identified include:

  • skilled attendants at delivery and newborn care;
  • care of low birthweight infants;
  • hygiene promotion;
  • prevention of mother-to-child transmission of HIV and paediatric treatment of AIDS;
  • adequate nutrition, particularly in the form of early and exclusive breastfeeding during the first six months of life;
  • complementary feeding combined with continued breastfeeding for at least two more years;
  • micronutrient supplementation to boost immune systems;
  • immunization to protect children against the six major vaccine-preventable diseases;
  • oral rehydration therapy and zinc to combat diarrhoeal disease;
  • antibiotics to fight pneumonia; and
  • insecticide-treated mosquito nets and effective medicines to prevent and treat malaria.

The challenge is to ensure that these remedies – along with comprehensive health services and a continuum of maternal, newborn and child health care – reach the millions of children and families who, so far, have been passed by.

Making maternal, newborn and child survival a global priority

While the development community works to achieve each of the health related Millennium Development Goals, its target in relation to child survival is Millennium Development Goal 4 (MDG 4), which aims to reduce the global under-five mortality rate by two thirds between 1990 and 2015. In 2006, the most recent year for which firm estimates are available, close to 9.7 million children died before their fifth birthday. Meeting MDG 4 implies that during the next seven years the number of child deaths must be cut in half – to fewer than 5 million per year—and at a much faster rate than before. The enormity of the challenge should not be underestimated, for the bulk of the efforts must be focused on the most difficult situations and circumstances: in the poorest countries, among the most impoverished, isolated, uneducated and marginalized districts and communities, within nations ravaged by AIDS, conflict, weak governance and chronic underinvestment in public health systems and physical infrastructure.

Business as usual will be grossly insufficient to meet the health-related Millennium Development Goals for children. This is abundantly clear in sub-Saharan Africa, the region furthest behind on almost all of the health-related MDGs, but also in several countries of South Asia and other parts the developing world.

The State of the World’s Children 2008 returns to a theme that marked the launch of the series in the early 1980s: putting children’s survival, health and development first. Then, as now, UNICEF and its partners aspired to reduce the number of child deaths by about half by a target date. Then, as now, it proposed simple, effective, low-cost, practical solutions and strategies to reduce child mortality and improve child health. Now, as then, it is inviting partners from all walks of life – from religious leaders to Goodwill Ambassadors, from mayors to Heads of State, from sports personalities to parliamentarians, from professional associations to trade unions – to join the child survival and development movement.

In order to achieve these objectives, the key stakeholders – governments and communities, donors and international agencies, non-governmental organizations and private sector collaborators—will need to unite their actions and partnerships in support of maternal and child survival and health. The survival of children must be placed at the heart of global efforts to advance humanity.

Learn about community health workers in Afghanistan